Our health and well-being are significantly impacted by the complex challenges the world is facing. The COVID-19 pandemic; climate change; political unrest; income, racial, gender, social, and other types of inequity are negatively impacting people everywhere, leading to surges of mental health concerns, the rise of chronic diseases, and surfacing the detrimental impact of stress. Digital transformation of healthcare is seen as a potential solution to many of the leading causes of death and disability by increasing access to care, empowering patients to take a bigger role in their health, and providing clinicians with personalized data for optimizing treatment for each individual patient.
Achieving digital transformation of healthcare and realizing its potential for improving global health and well-being is nested in lasting human behavior change. We might consider digital transformation’s impact on human behavior, its behavioral impact, as the potential key to unlocking the lasting change needed to transform our health and well-being globally.
At Newel Health, we’ve chosen behavioral impact as a cornerstone process and outcome for the research, design, and development of our digital therapeutics (DTx) pipeline. We currently serve the Parkinson’s Disease community with Soturi and people with hypertension with Amicomed, with plans to expand into new therapeutic areas in the future. This approach ensures that we can contribute to solving the biggest healthcare challenges the world faces today. In this article, we share a little about our approach to achieving behavioral impact and the principles upon which we base this work.
Behavioral impact is personal.
Changing human behavior requires a deep, empathic, non-judgmental understanding of human experiences and types of privilege accessible to each group whose behavior we hope to impact. Behavior change should always be consensual, and where behavioral impact efforts might fall short is in the assumption or expectation that as “experts,” we are able to decide what behavior others should change and how. At most, we can see ourselves as facilitators of change that bring our knowledge, skills, data, and accountability support to the people we work with and help them choose what might work best for them. Many of the behavior patterns required to impact health and well-being outcomes, like preventing disease, improving quality of life, and managing chronic disease symptoms, are dependent on changes to patterns conditioned in childhood and, as such, are deeply ingrained. These include behaviors such as exercise, food choices, alcohol consumption, tobacco smoking, mental health care, sleep hygiene, and stress management.
The World Health Organization (WHO) identifies such behavior patterns as the main risk factors for noncommunicable diseases, the types of health concerns that are collectively responsible for 74% of all deaths worldwide, such as heart disease, cancer, and diabetes. With the Dtx products we are creating at Newel Health, we hope to be partners to patients and clinicians alike in facilitating the change to such health behavior patterns and empowering both sides of the patient-clinician relationship with leading-edge information and tools to embark on their journeys as efficiently and empathetically as possible. Indeed, we see empathy as one of our key success metrics to ensure our process of behavioral impact prioritizes the personal nature of change.
Behavioral impact is contextual.
Digital therapeutics aiming to deliver behavioral impact need to be adapted to the context within which they are used, considering culture, language, faith or religion, health awareness, education, income, social infrastructure, and other pillars of functioning existing at the individual, neighborhood, community, and population levels of society. Socio-ecological models of health behavior can help us keep track of such influences and provide guidance on behavioral impact techniques such as personalization and communication strategy.
Contextual adaptation of behavioral impact in terms of information provided, data shared, and content offered is a frontier of behavioral impact work that is very much evolving and has the potential to realize its promises of increasing access and reducing inequity in the digital transformation of healthcare. At Newel Health, we work in four different languages, with four European and one North American cultural context. We look forward to exploring more on the behavioral impact significance of the contextual lens in the upcoming years.
Behavioral impact is a science.
Sustained human behavior change can be achieved with the strategic application of behavioral science, an interdisciplinary field integrating the human, natural, and environmental sciences (Mullins, 1996). The COVID-19 pandemic brought behavioral science to the front pages of our news and social discourse, centering on debates around pandemic regulation rollouts and compliance, vaccine uptakes, and more. Behavioral science, in fact, emerged well before we were faced with this global healthcare challenge. It was first studied in the early 1900s by John B. Watson, who is heralded as the “founder of behavioralism” and is best known for his research on the conditioning process. Conditioning is a central process in human behavior change. It is a form of learning where 1) a stimulus becomes increasingly effective in evoking a response or 2) a response occurs with increasing regularity in a well-specified stable environment. The type of reinforcement of the response (or behavior) will determine the outcome. This is the central process of behavioral impact in health behavior and highlights the importance of understanding the environment or context, facilitating learning, and applying the scientific method to predict and evaluate impact.
The field of behavioral science offers us many tools to predict behavior patterns and facilitate change, including theories and frameworks, techniques based on cumulative evidence, and more. We use models and theories of behavior change to help us map potential determinants of the target behaviors we are hoping to change and to efficiently identify which layers of the socio-ecological context of our target population might be at play. In recent years, some behavior change models have become more widely used than others. The COM-B model, for example, developed by Susan Michie and colleagues at the Centre for Behaviour Change at University College London, is gaining traction in the world of applied behavioral science and is one of the models we use at Newel Health also. Other better-known models include the Self-Determination Theory and the Social Cognitive Model.
Given the number of different behavior change models and theories out there, it can be challenging to choose the most appropriate one for any given behavioral impact challenge, and often, a combination of different models and theories, or a combination of individual theoretical constructs, might best reflect the socio-ecological picture at hand. At Newel Health, we identify combinations of models, theories, and constructs to give us the flexibility to accurately map the behavioral impact context as close to the target population’s experience, as possible, in addition to using models such as the COM-B in their entirety.
Behavioral impact is an art.
Mapping, predicting, and evaluating behavior patterns and outcomes might be a science, but creating the vehicle for facilitating the learning process of change is an art. Behavior change is personal, so the vehicle you take to achieve it must hold you in the space of understanding, support, and accountability. It is an art to create the right combination of user experience elements that becomes such a vehicle and leans heavily on human-centered design as its core process. We have chosen to elevate our human-centered design approach at Newel to include integration with behavioral science.
Newel follows a human-centered, interdisciplinary approach, bringing together our diverse team and partners’ expertise to meet the necessary factors of an effective DTx, including esthetic design, behavioral theory, evidence grounding, technical capacity, and demonstrated efficacy. We then implement the design with our highly skilled development team, powered by our proprietary development platform H.Core.
By integrating behavior change and human-centered design, we create processes that can produce an optimal impact on both digital and real-world behaviors, which in turn, are more likely to lead to desired health outcomes.
Behavioral impact evaluation
The digital health industry is calling for more robust research demonstrating the clinical outcomes of digital health solutions, and we are here to deliver. Robust research and scientific integrity are core values of Newel Health, and we are embarking on our journey of providing evidence of the clinical outcomes our products deliver in collaboration with the Michael J. Fox Foundation and our Parkinson’s Disease management product, Soturi. We look forward to sharing our findings with you as our research evolves, so watch this space.
We’re passionate about delivering behavioral impact through digital therapeutics to improve health and well-being globally and hope to connect with others on the same mission. We are building a global community of people interested in behavioral impact. Whether you’re a patient, clinician, pharmaceutical company, behavioral scientist, or someone passionate about solving the world’s biggest healthcare challenges, let’s stay in touch. Contact us here.
Mullins, Laurie J. (1996) Management and Organisational Behaviour. Fourth Edition.London, UK: Pitman Publishing (pp.116-120)